An ankle injury that includes syndesmosis ligament disruption is often accompanied by distal fibula comminution and/or a Weber C fibular fracture. In such a case, the syndesmosis ligaments that connect the fibula to the tibia are torn or ruptured and as a result, the relative motion of the fibula to the tibia must be constrained by surgical hardware to allow the ligaments to heal.
The standard of care for an ankle syndesmosis injury is to rigidly affix the fibula to the tibia using one or more screws that pass through the fibula and into the tibia. The screws should be in a transverse plane and angled to pass through the center of the fibula and the tibia incisura. When an anatomic lateral distal fibula plate is necessary to correct the fibular fracture, it is desirable to place syndesmosis screws through the plate to correct a more rigid construct.
Current anatomic distal fibula plates are designed to sit on the lateral aspect of the fibula. Screw holes in the syndesmotic repair region are perpendicular to the surface of such a plate, thus screwing through the plate at the proper angle to correctly reduce the fibula (roughly 30° anterior) is constrained by the off axis screw angle limitations of the hole. Additionally, even if it is angled properly, if the plate sits directly lateral then the origin of the hole is often too far anterior to pass through the midline of the fibula and tibial incisura. U.S. Pat. No. 7,235,091 discusses a method for fixation of ankle syndesmosis.